Neurologia-Neurocirugia Psiquiatria最新文献

The evolution of family therapy in Mexico is briefly reviewed. It is considered that the reach of this method is limited in institutions due to the lack of qualified psychotherapists with the different orientations of this speciality. The illness, as a sign of family imbalance within the humanistic concept, acquires an even if the treatment is given to the marital couple, the adolescent or the child. Family therapy helps in marital disagreements, behavior problems, anorexia, reactive depression, drug addictions, alcoholism and many other problems. The ISSSTE population has a stable location and is more or less homogeneous; in it family therapy is stimulating and possible; even though the institution imposes certain limitations to family therapy, the enthusiasm for this therapeutic method prevails.

48 patients with several types of seizures (following the international classification of epileptic seizures), were studied. Dipotassium chlorazepate was administered as a secondary antiepileptic drug. The cases were selected due to the severity of their seizures. The therapeutic results were evaluated with a daily record of seizures and attempt was made to correlate the serum levels of nordiazepam with the clinical results.

Examination of the speech mechanism (the vocal tract) frequently provides information about certain neurologic lesions. The speech, swallowing and respiratory patterns of patients with cerebellar, upper motor neuron, lower motor neuron and extra-pyramidal lesions (parkinsonism) were studied, 10 of each category. The patient's lingual, labial and velar movement was examined cineradiographically during production of four short speech samples and the oral, through esophageal structures, during chewing and swallowing. Videotape, with simultaneous voice recording, and 16 mm. film were used. Oral, pharyngeal and esophageal transit times during swallowing were determined. These quantified tests reveal distinctive differences in vocal tract physiology between patient groups. The specific physiologic patterns characteristic of each neurological lesion were discussed and illustrated with films. Each patient group in this study exhibited a distinctive profile distinguishing it from every other. The results also indicate that if only a portion of these studies was completed, the disorder might be erroneously classified. The findings emphasize the need for complete and detailed physiologic studies of the speech and swallowing of patients with neurologic lesions, as an aid to accurate diagnosis.

Epilepsy typifies instability in a complex control system. We have previously identified parameters of the thalamocortical motor system of the cat which correlate with epileptiform activity and are controlled by common anticonvulsants. This study is concerned with the control of such parameters by cerebellar stimulation, potencially promoting stability within the motor system. Under computer control, stimuli were delivered to both ventrolateral thalamus and cerebellar cortex, with multichannel recording of evoked responses obtained from sensorimotor cortex. Cortical evoked responses were plotted as an excitability curve (mean response amplitude as a function of pulse interval) or a family of threshold curves (mean response amplitude as a function of stimulus amplitude at various fixed intervals). The present study reveals that cerebellar epidural stimulation can reduce both the height and duration of the excitability curve, as well as increase the response threshold and reduce the saturation level of the threshold curve. The degree and direction of these parameter changes are dependent on the frequency, polarity, and amplitude of cerebellar stimulation, with the amount of parameter change exceeding that achieved by monotoxic doses of anticonvulsants. These data suggest that control of parameters related to excitability and threshold in the thalamocortical motor system may be the means by which cerebellar stimulation accomplishes control of clinical seizures.

A new method is presented to test language, worked out by one of the authors (R.R.L.). Briefly, it consists of the systematic and ordered exploration of the functions from the cortical sensory and motor areas, the interchange of the sensorial information from the sensory to the motor areas. Nine patients with different aphasic syndromes were examined independently from each other. The test was divided in two ranks; the sensory interchange and the motor-oral-manual. The Spearman Correlation Coefficient and its statistical meaning was calculated for each rank. For the internal reliability tests, the results achieved by two successive examination on the same patient were compared by the same explorer. For the external reliability, the results from two sucessive tests on the same patient were compared by two different explorers. The Spearman Correlation Coefficient rate in all the cases varied between 1 and 0.88 with a probability of more than 0.0005 and high statistical significance, with exception of the motor rank of case 4, where it was 0.87 with a probability of more than 0.005 and less than 0.0005 with still some statistical meaning.

At the Clínica Hospital Vasco de Quiroga, in Morelia, satisfying results were obtained using a psychotherapeutic approach that included abreaction of conflicts, exercise of directive authority, an attitude to relieve the patient of his guilt, advising, orienting and persuading the patients. This approach includes establishing rapport, obtaining information about the problem, elaborating a diagnostic impression, orienting oneself towards individual psychotherapy, and evaluating how frequently the sessions will be held, according to the therapist's affective neutrality, time available and capacity to listen.

The mechanisms of petit mal epilepsy remain a mystery despite successful therapy. Previous workers have proposed that paroxysmal activity of cortical inhibitory systems plays a role in absence seizures. In this study, we have compared the effects of bicuculline, a potent convulsive agent and GABA antagonist, with ethosuximide, a drug used to treat petit mal epilepsy, on the thalamocortical motor system of the cat. Under chloralose anesthesia, sequential pairs of pulses were delivered to ventrolateral thalamus (VL) varying either pulse amplitude or interval. The evoked responses were recorded from sensorimotor cortex, analyzed on-line by computer, and plotted as an excitability curve (mean response amplitude as a function of pulse interval), or a family of threshold curves (mean response amplitude as a function of stimulus amplitude at various fixed intervals). Administration of each drug resulted in increased thalamocortical excitability and decreased threshold to stimulation for short pulse-pair intervals, with diminished duration of the excitability curve. Increased alertness was produced by both drugs. Studies with grand mal anticonvulsants demonstrated entirely different effects. Because GABA is thought to be the primary inhibitory transmitter in VL and cerebral cortex, bicuculline would be expected to result in disinhibition. The similarity of the data for ethosuximide suggests that ethosuximide also suppresses inhibition in the thalamocortical motor system and adds further to the accumulating evidence of the role of inhibitory system in petit mal epilepsy.

The vicissitudes of institutional outpatient child psychiatry and the lessening of psychotherapeutic work due to the great amount of patients are described. It is mentioned how adolescents have been treated in groups and individually, and how family therapy was introduced. Play therapy has not been used due to the described time limitations. The handling of the environment surrounding the child is described, with basis on behavioral schemata; when the case requires it is focused psychoanalytically, in order to produce long-standing intrapsychic changes. It is remarkable how well adolescents accept group therapy, which helps their formation during the life stage they are going through.

In traditional psychiatric institutions, illness tends to become chronic: several psychiatric schools try to present this. One of them refers to institutional psychotherapy, which will vary according to the patient's pathology, the therapist's objectives, the structure of the institution and the patient's and therapist's ideology. The author describes a phenomenological-existential approach as opposed to the psychoanalytic approach, and classifies the types of therapy he applies in the institutional setting.

The author explains the characteristics of the psychiatric outpatient population in Hermosillo and mentions that these do not allow for the use of traditional psychotherapy. He underlines the importance of the affective ties of the patient with the institution (based on previously formed stereotypes). The author describes also several short therapy techniques, such as persuasion, suggestion, brief psychotherapy and group psychotherapy (for which special training is required). He tells of his experience using psychotherapy with psychiatric medication in an institution.